Business as Unusual

This could end up being the most boring post yet, so be prepared. The first half of my Mexican experience is over. It probably should be time to reflect, but I'm not in that frame of mind yet, so I'll tell you what I've been up to instead.

I gave a couple of talks the last couple of weeks, one to a group of docs and enfermeras at the local hospital, the other at CREE, the clinic where I work. Both in Spanish of course. The first presentation addressed the role of exercise in the rehabilitation of patients with cancer. This is a topic I admittedly knew little about, and I was given 8 days to prepare for it. I suppose this is penance for having too much fun down here. Those of you that are in the medical fields know how hard it is to keep up with the current literature. The problem here is at least 90% of the research in science these days is done in English, and little of it makes its way down the translation pipeline, so the docs here that don't at least read English (I would guess the vast majority) have added problems keeping up. Enter gringo. Anyway, the talk went well, but I blanked on how to say 500 (quinientos) en espanol, but the audience seemed to forgive me for it. I think putting together these talks has helped me with the past tense, since a good deal of the talks are literature reviews.

The second talk was more up my alley, a comparison of acute tendinitis and chronic tendinosis with rehabilitation implications. As I mentioned in the last post, I actually used this as a vehicle to compare therapy in Mexico with that in the U.S.. I knew it would create some tension with the physiatrists here, they tend to treat the PT's as techs, but I felt it was my duty to speak up in their behalf. Exit gringo. The reaction was mixed, actually some of the PT's were more shaken up by it then the docs, probably because I contrasted the more modern, differential diagnosis, evidence based, active type therapy that is commonly practiced in the states (and by some of the younger therapists here) with the passive, modality driven type that is more common here, especially with the older therapists. Anyway, I had a couple of therapists tell me that I have been a positive influence on them, and that they are going to try to read more, ask more questions, think more before treating. It kinda made me all warm and fuzzy inside, but, after brushing the tears from my eyes, I went back to work.

I must admit that I have gotten a little lazy studying Spanish the last couple of weeks. I'm trying to pay closer attention to what people say, so my comprehension is somewhat better, but I haven't been looking things up as much, etc. It really has been quite mentally exhausting, this process. I still fear the out of context question, because it often takes me a bit of time to figure out what is being said. My speaking is better, I have been able to include more tenses, including the imperfect, preterit, conditional, future, a bit in the present perfect, imperative, and have even been dipping my toe into the subjunctive occasionally.

As far as traveling goes, Aldo and I went on a jaunt last weekend. We were originally going to go straight to Holbox, this island in the northeast corner of la península Yucatán. I said originally, because we missed the exit from the autopista north to the island and ended up almost in Cancun before we realized our error. It really wasn't an error, though, because there wasn't an exit there. In Mexico, to save money, they only have toll stations every so often, so they simply don't have exits were you would think they would. Anyway, it ended up being fun for me, because I hadn't been to Cancun in some 27 years. Boy has it changed. But one thing that hasn't changed are the incredible beaches. We were walking along the beach and I noticed this archeological site nested between two hotels. It is hard to see, but I really got a kick out of it so I decided to post it. Cancun is dfferent from Playa del Carmen in two ways, there are more Gringos and bigger waves in Cancun. The reason there are no waves in Playa del Carmen is because the island of Cozumel is just off the coast and blocks them, you can actually see Cozumel from the beach at Playa del Carmen. Anyway, I love to body surf, so I let the waves pile-drive me into the sand for a few hours, we then cruized the malls (you might as well be in Los Angeles when your there), spent the night, and made our way to Hobox the next day. Here is a picture of those pile-driving waves, of course with perfectly blue water, sugar sand, etc, etc.

Holbox is an island famous for los tiburones ballenas (whale sharks) that migrate very close to shore in great density. They have tours that take you out to swim with them. It must be quite an experience, since whale sharks (the largest fish in the world) can grow in excess of 40 feet long, and there are often dozens of them at a time. During the whale shark season, Holbox is evidently a bustling place. Unfortunately, the season for the whale sharks doesn't start until late May, so we had to be content splashing around in the ocean, which was more like a therapy pool in both placidity and temperature. I have enclosed a picture of the front of our hotel, which was right on the beach (you can sort of see it in the background). All told, it was very relaxing. We then headed back to Campeche, and, save an out of control truck coming right at us that might have squashed us like a bug, the ride back was uneventful. I am heading off to Tulum in a couple of weeks, so I hope to have more fun stuff to talk about and share with you, but for now, Adios!!

Pinche Elton John and the Riviera Maya

I've been in the Yucatan for well over 2 months and I just now made it over to the Caribe side. The beaches along the Mexican Caribe, or Riviera Maya, are as nice as I've ever seen. White sand, ridiculously blue water, you know, the usual fantasy. Equally as nice are the tranquilidad and seguridad I've come to expect in the Yucatan. The weekend of Domingo de Resurreccion (Easter) comes with a 4 day puente here in Mexico, and Aldo, Aldo's brother Leonardo, and I took advantage of it by bopping over to the "other side".

On the way we made a couple of detours. First we hit Chicen Itza, probably the most famous Mayan ruin in Mexico. Unfortunately, Elton John was going to perform a concert there in two days, so they cordoned off a bunch of the site, including the front of the largest piramide (pyramid), the famous reclining man, and the largest cenote. Of course they didn't tell us that when we were buying tickets, and getting a refund in Mexico..... well, I'll leave that up to your imagination. Anyway, it was a bit disappointing. I've never liked Elton John, but now.... well, I'll leave that up your imagination too. Anyway, here is a picture of one of the nicer parts of the ruin that we could access.

After Chicen Itza, we went to a nice cenote (you can't spit in the Yucatan without hitting a cenote) in the middle of this town halfway between Merida and the Caribe called Valladolid. We stopped there for lunch and tooled around. They were doing some sort of shoot there, the place had a camera crew and a Mexican model getting all dolled up. Here is a picture looking up at the restaurant from the inside of the cenote.

Finally, we got to Playa del Carmen, which is about 50 miles south of Cancun (everyone here told me to take a miss on Cancun, too crowded and lousy access to the beaches). Playa del Carmen is plenty touristy too, but suprisingly, once you get off of Avenida Quinta (Mexico's answer to South Beach), you could just as easily be in any small town in the middle of the Peninsula. For instance, there was this great little taqueria run by two very Mayan looking woman just 1 block off the drag.

Our hotel was tucked up right next to the beach, right off of Avenida Quinta, was clean, had air conditioning, a pool, hot water, two queen sized beds, and was less than $100 U.S. a night. Mexico, you gotta love this place! Couldn't resist a picture of the beach right off of the hotel. There is an active night life in Playa del Carmen, it is totally asses to elbows every night until about 4 am. Aldo and his brother closed the bars every night, stumbling in around 5 or so, slept 4 hours, and were ready to go again. I managed to make it until 3 one night, was asleep by 12 the other two (which I'm sure is still some kind of record for me). If you happen to be older than 25, you feel older than 75 when your there.

After 4 days of such tonterias, we were ready to get back, and we blew across the peninsula on the suprisingly good carreteras that run all throughout the Yucatan (yet another misconception about Mexico is that the roads are all bad).

The difference between Mexico and the U.S. are so vast its hard to generalize, but I'm going to do it anyway. In (at least this part of) Mexico, people spend less time being angry, stressed, depressed, judgemental. They work hard, but when they leave work, they leave work. They have much less guilt about having fun. We could learn alot from them (I already have). I only hope that when I get back, I don't fall back into the same old stress fest we have come to accept in the states. Certainly there are things that are better in the states, hmm...for instance, coffee and beer. I'm sure there are others, I just would need more time to come up with them.

Work really has gotten to be more fun. I saw a patient for another therapist the other day who presented with a diagnosis of pes anserine tendinitis. It was obvious that isn't what he had, so I sent him back to the referring MD to see if he would consider an MRI to check for a possible medial meniscus tear. The referring doc wouldn't budge, so I told the PT that: 1. The patient wasn't going to get better with the current treatment, 2. Eventually, the patient would insist on getting an MRI, and 3. He will end up having a degenerative tear of the medial meniscus. Now, if you know me, you know I wouldn't be telling you this story if I didn't end up being right. Anyway, the doc didn't get mad at me, I'm now a bit of a rock star. Hardly a day goes by where I don't get a referrel with imaging included. I'm seeing the staff's family members, I casted a fractured hand the other day, I'm fabricating splints, giving mini-inservices on taping techniques, etc. It really is quite an experience. In addition, I'm going to give a talk for the entire staff here in 3 weeks (of course, in Spanish). I'm going to use the opportunity to contrast PT in the U.S. with PT in Mexico (OK, the list of things that are better in the U.S. is now coffee, beer, and PT). I'm going to use two different treatment approaches for chronic tendinosis as a vehicle. I just want to show the docs that the new generation of PT's being produced here in Mexico are capable of so much more than they realize (and utilize). Wish me luck.

Which brings me to the language part. I'm still struggling with comprehension, so much so that I've now decided I have audio dyslexia. I'm sure the diagnosis doesn't exist, but my audio processing skills are so terrible, they simply deserves a diagnosis all their own. I am improving in speaking though, and my reading skills are good enough to read novels in Spanish.

The daughter of one of my patients has taken pity on me, and I am going over to her house three times a week in the afternoons to talk with her. Her English is only slightly worse than my Spanish, so we trade off languages. She also has two incredibly precocious sons, one 5, the other 8, who are more than willing to correct my grammer and pronunciation. I used to think I was able to speak Spanish as well as a 6 year old, (which, according to Vicente Fox would make me 2 years better than George Bush) but now I'm not so sure.

All told its been quite a ride so far, but I'm not sure I will have much to talk about for quite awhile, so I will sign off for now. Chao.